Medicaid Claims Analyst

Stefanini Group is hiring!

Stefanini is looking for Medicaid Claims Analyst in Parsippany, NJ (Remote)

For quick Apply, please reach out to Shubham Singh - call: / email:

Work Hours: M-F (40 hours)

Work Location: Parsippany, NJ

Shift: 1st Shift (8:00 am - 5:00 pm) - Remote

The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes validating, verifying, disputing when necessary, and remitting payment for assigned state Medicaid agencies, SPAPs and Supplemental Rebates. Analyst is accountable for submitting payments within deadlines and in compliance with CMS guidelines and Teva rebate contract terms.



This position also provides assistance in resolving dispute resolution, weekly pay run activities, SOX audits, system upgrade/implementation and ad hoc analysis.



Essential Duties & Responsibilities Percentage of Time:Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into Medicaid systems and authorize transactions. Document errors and perform research.Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.20%Perform Claim Level Detail validation. Review suspect claim records and determine if record should be disputed for payment.20%Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Must have ability to work independently and make recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings.20%Complete Medicaid analysis and documentation on assigned states/programs. Communicate with manager for key findings and changes to state programs.10%Provide backup for Medicaid team members in any necessary functions and work with team to establish best practices within Teva Medicaid work environment.5%Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received. Upload data into Model N / Medicaid systems and authorize transactions. Document errors and perform research 5%Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency 5%Perform Claim Level Detail validation. Review suspect claim records and determine if record should be disputed for payment. 5%Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Must have ability to work independently and make recommendations on state disputes, apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings. 5%Complete Medicaid analysis and documentation on assigned states/programs. Communicate with manager for key findings and changes to state programs. 5%

Bachelor's degree or equivalent combination of experience, training and/or direct work related experience.Medicaid rebate experience in pharm environment.Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state and/or state agency or as Medicaid consultant or equivalent work experienceMinimum 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution. System Implementation and report writing.Revitas/Flex Medicaid and advanced Microsoft Excel skills.Strong ability to organize and manipulate large volumes of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews.Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validate system (or other comparable system) and advanced Microsoft Excel skills.Familiar with CMS Medicaid rules and state specific issues. Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.Strong ability to organize and manipulate large volumes of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews.Company/Industry Related Knowledge: Medicaid, Government Pricing and Rebate Pharmaceutical industry experience/knowledge prefer.



Core competencies:-

Analysis:Uses good analytical and data interpretation skills to analyze and resolve complex problemsAnalyzes processes and systems to improve efficiency and effectiveness through standardization, simplification and automation.



Developing Self and Others:Coaches and counsels associate to improve performance toward individual and department goalsContinuously expands technical and personal skills and business knowledge



Interpersonal Ability:Develops and fosters strong relationships with internal and external clientsBuilds reputation for being credible, trustworthy, and fairDisplays high level of integrity by doing what is right for the companyDemonstrates administrative value to shared service customers



Planning and Organization:Committed to meeting deadlinesDemonstrates sense of urgency by effectively prioritizing workload according to organizational needsDemonstrates the ability to manage multiple priorities



Technical skills:Possesses solid accounting skills particularly around accuracy and internal controlsDemonstrates advanced data management and Excel skillsUnderstands fundamental mechanics of rebate systems



Listed salary ranges may vary based on experience, qualifications, and local market. Also, some positions may include bonuses or other incentives.



Stefanini takes pride in hiring top talent and developing relationships with our future employees. Our talent acquisition teams will never make an offer of employment without having a phone conversation with you. Those face-to-face conversations will involve a description of the job for which you have applied. We also speak with you about the process including interviews and job offers.



About Stefanini GroupThe Stefanini Group is a global provider of offshore, onshore, and near shore outsourcing, IT digital consulting, systems integration, application, and strategic staffing services to Fortune 1000 enterprises around the world. Our presence is in countries like the Americas, Europe, Africa, and Asia, and more than four hundred clients across a broad spectrum of markets, including financial services, manufacturing, telecommunications, chemical services, technology, public sector, and utilities. Stefanini is a CMM level 5, IT consulting company with a global presence. We are CMM Level 5 company.